Ben H. Senturia

LV Middle Ear Effusions: Pathologic Changes of the Mucoperiosteum in the Experimental Animal

After it was demonstrated that effusions could be produced regularly in the experimental animal/ it became possible to make a systematic study of the associated histopathologic changes in the middle ear, bulla and eustachian tube. It is hoped that the knowledge acquired from such a study would provide information as to the manner in which effusions develop and thereby properly orient treatment.

LXXXIV Otorhinolaryngic Findings in Children with Voice Deviations Preliminary Report

A child whose voice deviates from the normally acceptable quality is handicapped overtly and subtly in many ways. Since the childs principal mode of social intercourse is by means of verbal communication, his peers or his teachers may not be able to hear or to understand him and consequently his social and educational development may be encumbered. The resultant embarrassment or emotional upset may cause the child to withdraw and cease normal interaction with his peers.

XXXV Classification of Middle Ear Effusions

The differential diagnosis of effusions is commonly based on morphologic findings, i.e., appearance and position of the tympanic membrane, the presence or absence of fluid in the middle ear, the patency of the lumen of the Eustachian tube and the audiologic findings. In the hands of the knowledgeable and experienced otologist a correct diagnosis based on these observations can be made in a high percentage of patients, but mistakes do occur.

Evaluation of Therapy

There is much conflicting information regarding the treatment of external otitis. Therefore an attempt was made to perform a controlled study of the effectiveness of a typical widely used combination of antibiotics and corticosteroids in aqueous and cream vehicles. Bacterial cultures and sensitivities were obtained before and during treatment to assess clinical progress. It was shown that the proper utilization of the antibiotic-steroid preparations was very effective in controlling the symptoms and inflammatory changes and in eliminating the exogenous bacteria.

Middle Ear Effusions: Further Studies on Experimentally Produced Pathologic Changes in the Dog Bulla

As over 60% of the long-term dog ears, in which cauterization of the nasopharyngeal eustachian tube orifice was performed, had mucus secreting glands in the lamina propria of the middle ear and bulla and as these were not found in the control ears, the findings were not likely coincidental. In this study and those reported earlier, it has been shown that following cautery to the nasopharyngeal orifice of the eustachian tube, islands of epithelium are buried in the granulation tissue found in the mucoperiosteum of the tympanum and bulla. Late in this experimental disease thickening of the mucoperiosteum persists and glands appear and persist in the fibrotic lamina propria of the middle ear and bulla. Focal hyperplasia of the epithelium was striking in two of the animals one year following the trauma.

Silicone implants in the mastoid portion of the temproal bone.

In an effort to overcome these undesirable sequelae, otologists have attempted to eliminate or reduce the size of the postoperative mastoid cavity. Various surgical techniques for obliteration of the cavity have been proposed and the efforts in this direction can be traced back to Preysing (1910) and Mayer (1911) who recommended skin flaps while Mosher (1911) suggested the use of a musculoperiosteal flap. However, for various reasons these practices were not widely accepted.

Book Review: An Atlas of Head and Neck SurgeryAn Atlas of Head and Neck Surgery By LoréJohn M.Jr., M.D. 2nd Edition, hard cover, 935 pages, indexed. W. B. Saunders Company, West Washington Square, Philadelphia, Pennsylvania, 19105. Price

This is an 88 page atlas containing color photomicroraphs of the normal microscopic anatomy 0 the temporal bone and a large selection of histopathologic sections of the temporal bone. As noted in the foreword, this book was prepared to be used by the clinician or student in the study of temporal bone slides. It was produced at the request of numerous individuals who visited the Los Angeles Foundation of Otology and saw their extensive collection of otologic material.

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We thus have a disease state otitis media with effusion that in most instances may resolve spontaneously; that may have no lasting ill effects; and for which specific treatment may often, if not usually, be inadvisable. Under the circumstances, mass screening programs would stand a good chance of promoting large-scale over-referral and over-treatment, much of the latter inevitably surgical.

Book Review: Scientific Foundations of OtolaryngologyScientific Foundations of Otolaryngology Edited by HinchcliffeRonald and HarrisonDonald. Hard cover, black and white illustrations, referenced, indexed, 976 pp, 1976. William Heinemann Medical Books publication, distributed by Year Book Medical Publishers, Chicago. Price:

These are the proceedings of a conference on Hearing Aids held at the Lexington School for the Deaf in May 1975. Eighteen contributions by various authors are grouped into five chapters: 1) Current Developments of Hearing Aids; 2) Electroacoustic Standards; 3) Hearing Aids for Infants and Children; 4) Hearing Aid Evaluation Procedures; and 5) Future Perspectives. The text is preceded by an Introduction written by R. Eisenberg. It brings a number of points into proper focus that otherwise might have become lost in the details of the text. By and large, the book is concerned with the nitty-gritty of hearing aid selection and fitting. There are many frustrated aU~iologis~s who are convinced that electroacoustic speerfications of hearing aids are useless. They simply fit hearing aids by trial and error, relying on the patients judgment. Yet, this is a haphazard procedure, especially with children. Their subjective selection is often not based on purely auditory criteria (Chap. by Zaner). It is completely useless, of course, with babies for whom early fittings are of paramount importance (Chap. by Rubin). Even in adults it is necessary to select aids with specifications that are at least ball park figures. All a patient is apparently able to do is to allow for some small corrections (Chap. by McCandless). The difficulties may have a two-fold cause: 1) After so many years of trying, we may still not assess all electroacoustic parameters of importance, or, what is more likely, our methods of doing so may not be adequate (Chap. by Ross). For example, the standard 2 cc coupler used for acoustic calibration does not sufficiently reflect the properties of the human ear, and the new Zwislocki coupler, especially when used in combination with the KEMAR manikin (Chap. by Levitt et al), may result in a real improvement. Also, attention to frequencies higher than the classical upper limit of 2 to 3 kHz is a needed break with tradition (Chap. by Villchur). [In this and several other respects, see also the recent monograph by D. Pascoe (Ann Otol Rhinol Laryngol Suppl, 23, 1975) who was not present at the conference. Pascoes article is a good companion piece to the present book.] 2) The audiometric data on which hearing aid fittings are usually based are not sufficient. Pure-tone thresholds are plainly not enough. Testing of speech perception against a noise background (preferably competing speech sounds) and the assessment of comfortable listening levels (Chaps. by Ross and by others) are steps in the right direction. This reviewer read with considerable interest the paper by Villchur, who shapes the hearing aid output according to the patients available speech range. To this end, he employs volume compression and frequency equalization in sequence. Patient evaluation of his device is still in an early stage; yet the procedure is innovative and deserves to be pursued. One gains the impression fr~m reading ~his book that, finally, some novel Ideas are bemg pursued. For a long time, interest was concentrated mainly on miniaturization to the detriment of other needs, and the basic design remained unchanged: a microphone followed by an amplifier and an earphone. However it was only recently that small microphones and earphones, both with extended high-frequency responses, became available. This book provides good evidence for the fact that audiologists are really needed in the care of hard-of-hearing patients. Surely, one can train technicians to do the routine audiometric work-up, and Industry can be relied on to improve hearing aids, once the need for technical improvements has been demonstrated. However, the evidence needed will come only from long-range studies on the particular problems of auditory perception by the hardof-hearing to which, among all the members of the health-care team, audiologists appear to be best suited. J. TONNDORF, MD

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The authors of a single volume text cannot take solace from the tabulation of every known fact about their chosen subject. Dr. English has wisely chosen to limit his audience. This text is designed to be of practical use to the student, resident and nonspecialist practitioner. These groups have somewhat dissimilar needs. Compromises were made with what was included specifically for each group. They appear to have been made consciously, intelligently, and for the most part, successfully.